FACT
SHEET
FOR IMMEDIATE RELEASE
April 30, 2015
Contact: CMS Media Relations
(202) 690-6145 | CMS
Media Inquiries
2016
Hospice NPRM CMS-1629-P
(CMS
updates to the wage index and payment rates for the Medicare Hospice Benefit)
Overview
On April 30, 2015, the Centers for
Medicare & Medicaid Services (CMS) issued a proposed rule (CMS-1629-P) that
would update fiscal year (FY) 2016 Medicare payment rates and the wage index
for hospices serving Medicare beneficiaries. The proposed hospice payment rule
reflects the ongoing efforts of CMS to support beneficiary access to hospice
care. The FY 2016 proposals and other issues
discussed in the proposed rule are summarized below.
Changes to Payments under the
Medicare Hospice Benefit
As proposed, hospices would see an
estimated 1.3 percent ($200 million) increase in their payments for FY 2016.
The $200 million increase in estimated payments for FY 2016 reflects the
distributional effects of the 1.8 percent proposed FY 2016 hospice payment
update percentage ($290 million increase), the use of updated wage index data
and the phase-out of the wage index budget neutrality adjustment factor (-0.7
percent/$120 million decrease) and the proposed implementation of the new
Office of Management and Budget (OMB) Core Based Statistical Areas (CBSA)
delineations for the FY 2016 hospice wage index with a one-year transition (0.2
percent/$30 million increase). The elimination of the wage index budget
neutrality adjustment factor (BNAF) was part of a 7-year phase-out that was
finalized in the “Medicare Program; Hospice Wage Index for Fiscal Year 2010”
final rule (74 FR 39384, Aug. 6, 2009), and is not a policy change.
Proposed Rule Details
Budget Neutrality Adjustment
Factor phase-out
This proposed rule describes the
final year of a provision of the FY 2010 Hospice Wage Index rule that phased
out the BNAF. The BNAF was implemented in 1997, when the former Health Care
Financing Administration (HCFA), now CMS, moved from an outdated wage index to
a more current and accurate method for determining hospice payments. The FY
2010 Hospice Wage Index final rule finalized a schedule to phase-out the BNAF
over seven years, reducing it by 10 percent in FY 2010 and by 15 percent
reductions each year from FY 2011 through FY 2016.
Alignment of Cap Year
This proposed rule would seek to
align the cap accounting year for both the inpatient cap and the hospice
aggregate cap with the fiscal year for FY 2017 and later. This allows for the
timely implementation of the IMPACT Act of 2014 changes (implementation in FY
2016) while better aligning the cap accounting year with the timeframes
described in the Improving Medicare Post-Acute Care Transformation Act of 2014
(IMPACT Act of 2014). The IMPACT Act of 2014 mandates that the hospice
aggregate cap be updated by the hospice payment update rather than using the
CPI-U for a specified time. In addition, we will align the timeframe for
counting the number of beneficiaries with the fiscal year, rather than the
accounting year.
CBSA-OMB Delineations
This rule proposes to adopt changes
to the delineation of Metropolitan Statistical Areas, Micropolitan Statistical
Areas, and Combined Statistical Areas, and guidance on uses of the delineation
of these areas reflected in the OMB Bulletin No. 13-01. These changes
would be implemented using a blended wage index with a one-year transition,
which aligns with the policy finalized for the Skilled Nursing Facility PPS and
Home Health PPS in FY 2015 and calendar year (CY) 2015, respectively. For each
county, a blended wage index would be calculated as fifty percent of the FY
2015 wage index using the current OMB delineations and fifty percent of the FY
2015 wage index using the revised OMB delineations.
Proposed Routine Home Care Rates
This rule proposes two different
payment rates for routine home care (RHC) that would result in a higher base
payment rate for the first 60 days of hospice care and a reduced base payment
rate for 61 or more days of hospice care. These differing payment rates would
further the goal of more accurately aligning the per diem payments with visit
intensity and the cost of providing care.
Service Intensity Add-On
This proposed rule proposes a
Service Intensity Add-On (SIA) Payment for FY2016 and beyond in conjunction
with the proposed RHC rates. The proposed SIA payment
is a payment that would be made for the last seven days of life in addition to
the per diem rate for the Routine Home Care (RHC) level of care if certain
criteria were met. The payment would not be made to providers with
patients residing in SNF/NFs due to the concerns with the provision of hospice
care in these settings as highlighted by the Office of Inspector General and
the Medicare Payment Advisory Commission. The SIA payment policy encourages
visits to patients at the end of life and improves provider accountability.
Additionally, the policy begins to address industry and other organizations’
concerns regarding the need for increased payment for more resource intensive
days.
Clarification Regarding
Diagnoses on Claim Form
Based on the numerous comments
received in previous rulemaking, and anecdotal reports from hospices, hospice
beneficiaries, and non-hospice providers, we are concerned that some hospices
are neither conducting a comprehensive assessment nor updating the plan of care
as articulated by the Conditions of Participation to recognize the conditions
that affect an individual’s terminal prognosis.
Therefore, we are clarifying that
hospices are required to report all diagnoses identified in the initial
and comprehensive assessments on hospice claims, whether related or unrelated
to the terminal prognosis of the individual. This is in keeping with the
requirements of determining whether an individual is terminally ill. This would
also include the reporting of any mental health disorders and conditions that
would affect the plan of care as hospices are to assess and
provide care for identified
psychosocial and emotional needs, as well as, for the physical and spiritual
needs.
The proposed rule went on display
on April 30, 2015 at the Federal Register’s Public Inspection Desk and
will be available under “Special Filings,” at https://s3.amazonaws.com/public-inspection.federalregister.gov/2015-10422.pdf
or http://www.federalregister.gov/inspection.aspx.
After 05/05/2015 this rule will be
available online at http://federalregister.gov/a/2015-10422
For further information, see http://www.cms.gov/Center/Provider-Type/Hospice-Center.html.
Public comments on the proposal will be accepted until June 29, 2015.
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